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Australian Dental Journal
The official journal of the Australian Dental Association
Australian Dental Journal 2012; 57: 2–10
REVIEW
doi: 10.1111/j.1834-7819.2011.01640.x

Clinical considerations for increasing occlusal vertical

dimension: a review
J Abduo,* K Lyons 
*Faculty of Dentistry, The University of Western Australia, Crawley, Western Australia, Australia.
 Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.

ABSTRACT
The purpose of this article is to discuss the clinical considerations related to increasing the occlusal vertical dimension
(OVD) when restoring a patient’s dentition. Thorough extraoral and intraoral evaluations are mandatory to assess the
suitability of increasing OVD. In the literature, multiple techniques have been proposed to quantify OVD loss. However, the
techniques lack consistency and reliability, which in turn affects the decision of whether to increase the OVD. Therefore,
increasing OVD should be determined on the basis of the dental restorative needs and aesthetic demands. In general, a
minimal increase in OVD should be applied, though a 5 mm maximum increase in OVD can be justified to provide adequate
occlusal space for the restorative material and to improve anterior teeth aesthetics. The literature reflects the safety of
increasing the OVD permanently, and although signs and symptoms may develop, these are usually of an interim nature.
Whenever indicated, the increase in OVD should be achieved with fixed restorations rather than a removable appliance, due
to the predictable patient adaptation. The exception to this is for patients with TMD, where increasing the OVD should still
be achieved using removable appliances to control TMD-associated symptoms before considering any form of irreversible
procedure.
Keywords: Occlusal vertical dimension, facial aesthetics, temporomandibular disorder, tooth wear, occlusion.
Abbreviations and acronyms: CLS = crown lengthening surgery; IORS = interocclusal rest space; OVD = occlusal vertical dimension;
TMD = temporomandibular disorder; TMJ = temporomandibular joint.
(Accepted for publication 15 September 2011.)

Increasing the OVD from the clinical perspective has

INTRODUCTION
been reported to facilitate the treatment of patients
The Glossary of Prosthodontic Terms defines the presenting with generalized and complex dental
vertical dimension as the distance between two selected abnormalities such as generalized tooth wear and
anatomic points.1 The vertical dimension when the significant occlusal irregularities.7–9 However, there is
mandibular teeth are occluding with the maxillary teeth still considerable debate in the literature about
is defined as the occlusal vertical dimension (OVD). treatment modalities used to increase OVD. Some
The OVD for dentate individuals is mainly determined authors have assumed that the OVD is constant
by the remaining dentition, hence loss of tooth sub- throughout an individual’s life, and any alteration of
stance might influence the OVD. A loss of OVD can the OVD will subsequently interfere with the
significantly affect patient function, comfort and physiology of the masticatory system and the patient’s
aesthetics.2 ability to adapt.10,11 The reported consequences of
Several authors have commented on the dyna- increasing the OVD are hyperactivity of the masticatory
mic nature of the dentoalveolar complex and masti- muscles, elevation in occlusal forces, bruxism and
catory system.3–6 So, whilst the loss of OVD is a temporomandibular disorders (TMDs).2,10,11 On the
possible consequence of tooth wear, the original contrary, other authors have reported that such
OVD can be preserved by a dentoalveolar compen- symptoms are transitory.12–15
satory mechanism involving the extrusion of worn Although evidence regarding the implications of
teeth.3–6 increasing OVD is still lacking, the rehabilitative
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Increasing occlusal vertical dimension

procedures involving the increase in OVD should be ical space, and therefore an IORS of more than 2 mm
approached with caution. The aim of this narrative indicates that the OVD can be safely increased.2
review article is to discuss the clinical considerations However, the literature suggests that there are four
related to increasing the OVD. limitations associated with positioning the mandible at
rest: (1) for the same individual, different mandibular
positions can be obtained at different examination
CLINICAL EVALUATION
periods. This has been attributed to the influence of
In contemporary dentistry, emphasis should be placed muscle activity and fatigue.21,22 A suggestion has been
on conservative management strategies.16 Since increas- made that the true rest position of the mandible, where
ing the OVD by restorative means involves multiple all the muscles are relaxed, does not exist;23 (2) loss of
teeth in at least one arch, it is regarded as an extensive, OVD is associated with a parallel loss of the vertical
costly and time-consuming procedure. Prevention strat- dimension when the mandible is at rest. This means the
egies and conservative measures should be the clini- IORS is vulnerable to a similar loss in dimension to the
cian’s main priority. Conservative management for OVD.24,25 Such a phenomenon would underestimate
patients with reduced vertical tooth height includes the IORS and, subsequently, the loss in OVD; (3) the
dietary counselling, fluoride application, exclusion of mandibular rest position occurs at a zone rather than a
dietary disorders, controlling parafunctional habits and specific level. This finding is supported by clinical studies
management of gastro-oesophageal reflux disorder. that have confirmed the ability of the patient to adapt
As the prevention of tooth wear is not the purpose of after increasing the OVD;12–15,26,27 and (4) there is
this article, the readers are referred to other references substantial variation between clinicians in evaluating
on this topic.7,8,17,18 Nevertheless, it is important to the resting position of the mandible. Clinically, an
state that increasing the OVD should only be consid- accurate determination of the vertical dimension is
ered where comprehensive prosthodontic rehabilitation difficult when the landmarks are located on movable
is justified. skin tissues,28 and where the mean facial measurement
Comprehensive extraoral and intraoral assessments could account for only half the skeletal movement.29
are mandatory before considering an increase in the Two questions would seem relevant for any given
OVD. This is important since increasing the OVD is clinical situation: what is the most reliable technique for
normally part of a comprehensive rehabilitation rather determining OVD loss? And what is the significance of any
than a single treatment modality. A thorough assess- such loss? Unfortunately, both questions have not been
ment process should reveal the merits of altering the answered in the literature. Table 1 presents the available
OVD and allow the clinician to consider suitable clinical techniques to determine the loss of OVD. In
treatment options. Given that the standard patient general, many of the proposed techniques have been
examination procedure is followed, the following adapted from complete dentures fabrication procedures.
extraoral and intraoral assessments should be consid- Although all the stated techniques have been found to be
ered for patients in need of an increase in OVD. useful, none have been assessed to be scientifically more
accurate than another.30 It has been suggested that in
order to improve the accuracy of the recording procedure,
Extraoral considerations
more than one method should be used.19
The literature suggests several extraoral factors be The available clinical trials that increased the
considered prior to the clinical decision to increase the OVD beyond IORS (4–5 mm inter-incisally) did not
OVD. These include the magnitude of OVD loss, facial reveal patient maladaptation or pathological reac-
profile and aesthetics, and status of the TMJ. tions.12–15,26,27 On this basis, it could be stated that
the determination of the OVD increase should not be
based on IORS values.
Magnitude of OVD loss
Many authors recommend an evaluation of an actual
Facial aesthetics
versus apparent loss of OVD.2,19,20 One means of
evaluation is the use of interocclusal rest space (IORS), The determinants of facial aesthetics are the sagittal
i.e. the difference in vertical dimension between when profile, facial tissues appearance, lip morphology and
the mandible is at rest and when the mandible is in teeth display.31 Sagittal assessment of the face can reveal
occlusion.1 For dentate individuals, the initial reference mandibular pseudo-prognathism which might be a sign
is the OVD of the existing dentition. Subsequently, the of OVD loss and overclosure of the mandible. This
vertical dimension when the mandible is at rest can be observation has been confirmed clinically7 and anthro-
evaluated clinically. The rationale behind measuring the pologically.32 On the basis of a cephalometric analysis
IORS is to determine how much to increase the OVD. of dry skulls, Fishman found that tooth wear resulted
An IORS of 2 mm has been suggested as the physiolog- in a reduction of arch width and gonial angle that
ª 2012 Australian Dental Association 3
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J Abduo and K Lyons

Table 1. Described clinical techniques for assessment of OVD loss

Technique Description Advantages Disadvantages

Pre-treatment – Visual assessment of old diagnostic – Approximates the loss of clinical – Old models are rarely available
record models crown height78 before treatment79
– Previous photograph – Formulates baseline record8
Incisors height – The distance between the gingival – Approximates the loss of clinical – Poorly represents the actual loss of
measurement margins of the maxillary and crown height OVD5
mandibular anterior teeth when – Applicable clinically – Affected by the original anterior
they are in occlusion. A distance of – Aesthetically relevant tooth relationship
less than 18 mm indicates loss of – Measures the severity of tooth
OVD wear80
Phonetic – S sound to measure the closest – Reproducible81 – Variable outcome for patients with
evaluation speaking space – Applicable clinically Class II and III occlusions19
– F sound to locate the incisal edges – Indicates patient adaptation after – Poorly represents the actual loss of
of anterior maxillary teeth loss of tooth tissues OVD82
– M sound to locate the mandible in – Indicates incisal tooth relationship – More useful for complete dentures
rest position – Locates the incisal edges of maxillary construction28,77
anterior teeth in relation to lower
lip77
Patient – Mandible positioning at rest – Applicable clinically – Minor muscles tension will lead to
relaxation – Visualizes the facial appearance inaccurate measurements28,84
at rest83
– Ensures the lips are meeting
Assessment – Evaluation of facial tissues and – Applicable clinically – Arbitrary evaluation of the facial
of facial musculature at rest – Visualizes the facial appearance aesthetics28,84
appearance at rest83
– Ensures the lips are meeting
Radiographic – Cephalometric assessment of – Highly accurate and – Controlled setting is mandatory
evaluation maxillomandibular relationship reproducible85,86 – Additional equipment and
– Indicates incisal tooth relationship87 radiation85
Neuromuscular – Recording EMG muscle activities – Useful clinical and research tool for – The devices are rarely available in the
evaluation where minimal muscle activity OVD evaluation88,89 clinical setting
indicates the mandible is at rest – Accurate and reproducible90,91 – Great expertise is required
position – Rigorously controlled recording
conditions are necessary89

may contribute to the overall mandibular pseudo- increasing the OVD might reverse the consequence of
prognathism.33 Likewise, Varrela found that a worn OVD loss and restore facial morphology.28,35 Mohindra
dentition is associated with a reduced gonial angle and and Bulman reported an improvement in facial aesthetics
reduced face height.34 Crothers anticipated mandibular by the insertion of complete dentures constructed at an
pseudo-prognathism to develop from one or more of the increased OVD.36 However, Gross et al. reported that
following factors: loss of OVD and subsequent forward after experimental increase of the OVD by 2–6 mm for
rotation of the mandible; dentofacial bone remodelling dentate individuals, there was an insignificant extraoral
after tooth wear; an edge-to-edge anterior tooth rela- improvement of facial tissues appearance.37 This finding
tionship after loss of vertical tooth height; and anterior can be attributed to the significant loss in OVD for
positioning of the mandible due to the loss of anterior edentulous individuals without compensation in com-
tooth guidance.24 The severity of mandibular pseudo- parison to dentate individuals. In addition to increasing
prognathism can be subjectively assessed by reviewing an OVD, the effect complete dentures have on facial
old photograph of a patient’s facial profile. Although aesthetics could be related to horizontal support of the
increasing the OVD reduces the pseudo-prognathism of facial tissues from the dentures.
the mandible,24 the significance of this effect is doubtful The upper lip position in relation to the incisal edges
since increasing the OVD for dentate individuals is of maxillary anterior teeth determines the teeth display
limited to 5 mm inter-incisally, which may not be while smiling and at rest.31 Insufficient display of the
sufficient to induce facial alterations. maxillary anterior teeth can be improved by lowering
From the frontal view, several facial implications can the occlusal surface of the maxillary teeth. Further,
manifest after loss of OVD including altered facial increasing the OVD allows the establishment of an
contour, narrowed vermillion borders and an overclosed incisal overjet that can augment the support of the
commissure.24 These implications are exacerbated by maxillary lips. Subsequently, an overbite can be incor-
increased mandibular pseudo-prognathism.24 As long as porated which can allow the maxillary incisal edge to
the lip competence is not compromised, it is thought that be placed parallel to the lower lip, rendering a more
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Increasing occlusal vertical dimension

aesthetic appearance.31 On the contrary, excessive increase in the OVD can be incorporated into the
display of the gingival tissues will not be improved by occlusal appliance. On the basis of patient adaptation
increasing OVD. Rather, aesthetic crown lengthening to the occlusal appliance, permanent restoration at the
surgery (CLS) should be considered.38,39 increased OVD can then be performed.45,50
It could be speculated that although the loss of OVD
can lead to changes in sagittal profile and facial tissues
Intraoral considerations
appearance, there is no compelling evidence that
increasing the OVD for dentate individuals by restor- Intraoral assessment involves examining the following
ative means reverses these morphological changes. parameters: remaining tooth structure and occlusion.
Therefore, it is important to emphasize that increasing
OVD is not indicated to improve facial aesthetics.
Remaining tooth structure
Nevertheless, teeth display might improve by lowering
the maxillary occlusal plane after increasing OVD. The prognosis of a dental restoration is directly
determined by the amount of remaining tooth struc-
ture.51 For generalized loss of vertical tooth height, the
Temporomandibular joint status
clinician is faced with the dilemma of limited remaining
The prevalence of temporomandibular joint disorders tooth structure that is necessary for adequate retention
(TMDs) has been reported to be 7–10% within the and resistance of the restoration. The original tooth
population.40,41 Therefore, it is not uncommon to height determines the active preparation height,
encounter patients with signs and symptoms of TMD which can be defined as the vertical distance between
seeking routine dental care. However, TMD has been the preparation margin and the occlusal-axial line
found to primarily affect young and middle aged angle. In order to avoid compromising the preparation
adults.40,42 Considering that this group of patients height, increasing the OVD should be considered to
might not suffer from significant loss of OVD,43 it provide adequate space to accommodate the restorative
could be speculated that the development of TMD is material. The merit behind this technique is more
not associated with the loss of OVD. This assumption prominent in generalized loss of tooth height mani-
is supported by the clinical observation that attrition is fested from tooth wear. As a result of this approach, the
not associated with an increased prevalence of TMD.44 teeth will be subjected to less pulpal trauma. In
Through routine clinical assessment, it is critical to addition, by utilizing the available vertical height of
assess the status of the temporomandibular joint (TMJ) the tooth, the indication for adjunctive crown length-
before intervention therapy. TMJ evaluation is com- ening surgery is minimized.
prised of assessment of joint and muscle pain, mandib- Given that tooth preparation taper for a crown is
ular movement and associated sounds.7,8 Despite the 10–20 degrees for a posterior tooth, according to
lack of compelling evidence supporting a relationship Parker’s et al. calculations, 3 mm is the minimal
between the OVD and TMD, TMJ evaluation will preparation height.52 Similar findings were confirmed
allow observation of the initial TMJ status of the by Maxwell et al. regarding anterior teeth and
patient. Even if increasing OVD may not exacerbate premolars.53 Since only 46% of prepared molars
TMD signs and symptoms, patient adaptation might be exhibit an adequate resistance form,54 according to
masked by the pre-existing discomfort. Therefore, Goodacre et al.,51 at least 4 mm is recommended as the
comprehensive restorative treatment involving an minimal preparation height. If this height is not
increase in OVD should be approached with caution available, then auxiliary retention and resistance
for patients with TMD. Multiple authors have sug- features should be incorporated. Therefore, with
gested stabilizing TMD patients and minimizing the increasing OVD, it is possible to crown teeth with an
signs and symptoms with a removable occlusal appli- original clinical crown height of 3 mm without
ance before the commencement of irreversible prosth- adjunctive therapy. As a result, it appears that the final
odontic treatment.7,45 preparation height is a critical determinant of the need
To date, there is more evidence to support conserva- and the magnitude of the OVD increase.
tive management of TMD such as with occlusal When there is limited vertical tooth height, an
appliances, behavioural therapy, physiotherapy and alternative approach to increasing OVD is CLS.2
jaw exercises than permanent occlusal alteration that However, the possible sequelae of CLS of multiple
has not yet been proven.46–48 Where there is a genuine teeth in an arch are loss of a significant amount of soft
need to increase OVD, it should be carried out using a and hard tissues, the effect on the emergence profile and
conservative method such as with an occlusal appli- the development of a black triangle. The exposure of
ance.46,47,49 Therefore, for patients with TMD, the root surfaces excludes the use of adhesive restorations,
occlusal appliance has a dual purpose: stabilizing the and necessitates restoring the crown lengthened teeth
TMD and increasing OVD. The intended permanent with full coverage restorations. In relation to aesthetics
ª 2012 Australian Dental Association 5
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J Abduo and K Lyons

of the anterior teeth, CLS is an excellent procedure to margin staining, marginal fracture and surface rough-
improve the contour of the gingival tissues and enhance ness.64 Therefore, it appears that increasing the OVD
the aesthetic display of the anterior teeth for patients by direct composite resin restorations is a predictable
with a high or average lip line when smiling.38,39 medium-term option, while metal or ceramic onlays are
However for a low lip line, there will be minimal more adequate as long-term options.
improvement of the aesthetic display unless the OVD is
increased. Further, CLS by itself will not improve the
Occlusion
relationship of the anterior teeth. One of the concerns
associated with CLS is the increase in the crown-to-root Clinically, unopposed teeth have been reported to be
ratio that might be attributed to increased teeth prone to overeruption, which can create occlusal
mobility and a compromised prognosis. However, there interferences.65 For some patients, increasing OVD
is no compelling evidence regarding the negative effect facilitates occlusion reorganization and the achieve-
of an increased crown-to-root ratio.55 A recent system- ment of an even occlusal plane.9 Subsequently, an
atic review reported that a severely reduced but healthy invasive sacrifice of tooth structure can be avoided.
periodontal support is not a compromising factor for As a result of a worn anterior dentition, the mandible
the longevity of teeth utilized as abutments for fixed tends to be habitually located more anteriorly. By
dental prostheses.56 recording the difference in the horizontal mandibular
For a clinical crown height of less than 3 mm, CLS is position when the mandible is in centric relation and
the only means of providing for adequate preparation maximal intercuspation, a horizontal space can be
height by exposing more tooth structure. Nevertheless, obtained inter-incisally.66 This space can be utilized to
for excessively short teeth, the rehabilitative treatment provide adequate room for restoration of the anterior
can be a combination of increasing OVD and CLS as teeth. The advantage of using this method is the
an adjunctive treatment. The clinician should decide feasibility of restoring worn anterior teeth without
on the best compromise of the multiple treatment increasing the OVD.
options to minimize the invasiveness of the overall Loss of posterior tooth support has been cited as
treatment. probably the main cause for loss of OVD in dentate
With the continuous development of adhesive tech- individuals.2 The implications of losing the posterior
nologies, it is possible to bond an onlay restoration to teeth are the overloading of the remaining anterior teeth
the remaining tooth structures, even if the remaining and increasing the potential to wear. A nine-year
structure is less than 3 mm. The advantages of adhesive clinical trial comparing the occlusal stability of patients
restorations are the conservative nature of the operative with complete dental arches and shortened dental
procedure in relation to the tooth and periodontal arches revealed that patients of both groups exhibited
tissues, and less clinical time required for the applica- a similar overbite and occlusal tooth wear.67 More
tion and completion of the treatment. However, anterior teeth in the shortened dental arch group were
significant care should be taken while bonding the in occlusion. Since the occlusion of the shortened dental
restoration to dentine and the maximum amount of arch group exhibited relative stability, the authors
enamel should be used.57 The available materials for concluded that a new occlusal equilibrium was
bonding are metal, ceramic and composite resin. obtained.67 On the contrary, one cross-sectional study
Chana et al. reported a 89% survival rate of resin confirmed that patients with an extremely diminished
bonded metal veneers for a duration of 60 months.58 posterior tooth support (0 to 2 occluding units) tended
Likewise, Jamous et al. found that 80% of resin to exhibit an anterior dentition with more prominent
bonded metal restorations survived after seven years.59 spacing, heavier occlusal contacts, occlusal wear,
In relation to ceramic onlays, Wagner et al. reported mobility and vertical overlap.68 All of these findings
that the survival of ceramic onlays was 81% in seven can eventually lead to the loss of OVD. Therefore, for
years. In the same study, they found that the perfor- patients with extremely shortened dental arch, it is
mance of ceramic onlays is comparable to metal important to eliminate the potential cause of OVD loss
onlays.60 Similarly, Otto and Schneider found the by achieving a stable posterior occlusion before con-
survival rate for ceramic onlays to be 89% up to sidering increasing the OVD.
17 years.61 As a simpler option, Hemmings et al. have Patients with a worn anterior dentition suffer from a
shown favourable short- to medium-term performance loss of clinical crown height and the possibility of
of direct composite resin restorations when placed in a development of an edge-to-edge incisal relationship.6,7
thickness of 2 mm or more.62 Poyser et al. reported a As a result, the aesthetic appearance is affected and the
survival rate of 94% after two years for composite resin anterior guidance is lost.69 In addition to an aesthetic
restorations placed at an increased OVD.63 Composite improvement, increasing the OVD rectifies the anterior
resin restorations have the advantages of ease of repair tooth relationship, by re-establishing an overjet and
or modification. However, they still suffer from wear, overbite, and facilitating the establishment of anterior
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Increasing occlusal vertical dimension

tooth guidance.9,69 According to the modern theories of were reviewed in a follow-up study that confirmed the
occlusion, anterior tooth guidance is desirable as it is long-term patient adaptation after increasing OVD.12
believed to protect the posterior teeth in eccentric More recently, in a retrospective study by Ormianer
movements.70–72 and Palty, the OVD was increased up to 5 mm for 30
Patients with a steep anterior tooth guidance can patients requiring whole arch prostheses supported by
benefit significantly from increasing OVD as it will teeth or implants.13 Despite all the patients adapted to
alleviate the broad area of anterior tooth contacts and the increase in OVD, a few patients with implant-
provide shallower and less constrained angle of disclu- supported prostheses suffered from prolonged grinding
sion.9,69 Even though a steep anterior tooth guidance that resolved within 2–3 months after administering an
does not appear to be contributory to the development occlusal splint.
of pathological signs and symptoms, it still poses a In relation to the method of increasing OVD, the
daunting challenge for the restoration of anterior studies that increased OVD with fixed prostheses12,14
teeth.69 indicated less symptom severity than the studies that
Therefore, increasing the OVD facilitates reorgani- increased OVD with a removable appliance.15,26,27
zation of the occlusion by elimination of occlusal This outcome could be attributed to the fixed prosthe-
interferences, provision of adequate overjet and over- ses having the advantages of being fixed in the mouth,
bite, and alleviation of steep anterior tooth guidance. mimicking natural tooth morphology, minimizing
bulkiness with reduced interference with speech and
improved overall comfort. In addition, the fixed nature
FEASIBILITY OF INCREASING OVD
of the prosthesis may enhance patient compliance and
Increasing OVD has been considered by some authors acceptance of the treatment. Therefore, whenever
to be a hazardous procedure that can violate a patient’s possible, the increase in OVD should be performed
dental physiology and adaptation.10,11 The basis of for TMD-free patients with fixed restorations rather
such claims is the thought that OVD occurs at a specific than with a removable appliance. Removable appli-
level that should be maintained through an individual’s ances could be a source of patient maladaptation due to
life.2 factors other than increased OVD.
In the literature, multiple articles have challenged the In relation to the magnitude of increasing the OVD, an
hypothesis of the negative implications of increasing increase of up to 5 mm inter-incisally is a feasible
OVD beyond the IORS.12–15,26,27 In general, their alteration.12–15,26,27 Such outcomes support the assump-
outcomes reflect the safety, patient adaptation and tion of other investigations that physiological OVD
predictability of increasing the OVD. This is true in occurs at a range, commonly known as the comfort zone,
relation to TMJ and masticatory muscle health. How- rather than a specific constant level. Subsequently, it
ever, the available studies suffer from a lack of could be expected that the patient can adapt to an
randomization and control group. In addition, signif- alteration in OVD as long as it is confined to this zone.
icant variation exists in relation to the subjective The possible adaptation mechanisms to an increased
methods to assess patient adaptation. All the available OVD could be masticatory muscle lengthening and
studies had a limited number of participants and it relaxation, dentoalveolar maturation, or a combination
could be assumed that they are not representative of the of these two mechanisms. In a two-year study, after
whole population. increasing OVD by covering the whole arch, Ormianer
Carlsson et al. increased the OVD by 4 mm for six and Gross found that relapse of the OVD to its original
participants with removable appliances temporarily value was minimal.12 This finding supports the theory
cemented on the occlusal surface of the mandibular that muscle relaxation and changes in muscle length
posterior teeth and the canines. After seven days, were the primary adaptation mechanisms,73 rather than
despite all the participants reported subjective symp- returning to the original OVD by dentoalveolar matu-
toms, five of them reported resolution of the symptoms ration. Further, this outcome is in accordance with the
within two days. One participant could not adapt to the finding of Ormianer and Palty that reported patient
intervention.15 However, the maldaptation could have adaptation even when implant-supported prostheses
been due to the appliance design and associated were utilized.13 On the contrary, after increasing OVD
bulkiness rather than the increase in OVD. In two by covering the anterior teeth only, Dahl and Krogstad
studies, Dahl and Krogstad increased the OVD for 20 reported that occlusal stability was obtained orthodon-
participants up to 4.7 mm by using anterior removable tically by intrusion of the occluding segments of the
splints. All symptoms resolved within two weeks, with arch and extrusion of the non-occluding segments of
lisping being the most common symptom.26,27 Like- the arch.27 Therefore, it could be assumed that an OVD
wise, Gross and Ormianer reported resolution of minor increase by partial arch coverage will lead to dento-
symptoms after two weeks of increasing the OVD up to alveolar alteration, while the complete arch coverage
4.5 mm with fixed prostheses.14 The eight participants will lead to immediate establishment of an occlusion
ª 2012 Australian Dental Association 7
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J Abduo and K Lyons

with minimal alteration in the dentoalveolar complex. determinants for increasing the OVD are the remaining
Although the clinical significance of this observation is tooth structure, the space available for the restoration,
doubtful, clearly complete arch coverage will establish occlusal variables and aesthetics. Minimizing the
the occlusion in a more controlled way. increase in OVD is useful to reduce the overall
Although a greater increase cannot be assumed to be complexity of the prosthodontic treatment. Increasing
hazardous, it should be stated that a greater increase in OVD by more than 5 mm is rarely indicated. Further-
the OVD implies significant escalation in the rehabil- more, increasing OVD is a safe procedure, and any
itation complexity that might be difficult to justify. consequential signs and symptoms tend to be self-
Since any restorative material can be applied on the limiting. The use of a removable splint to increase OVD
occlusal surface in a space of 2 mm,51,62 a 4 mm for TMD-free patients is not indicated as it might
interarch space will be adequate for comprehensive generate signs and symptoms related to splint wearing
rehabilitation. Subsequently, an OVD increase greater rather than OVD increase.
than 5 mm inter-incisally is rarely indicated from the
clinical perspective.
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